On Self-Promotion

I am 60-years wise. I have been a doctor since 1983 and have been doing emergency medicine since 1986. I am an accidental academic with a nontraditional route into emergency medicine. I did three years of general surgery residency with an intention of working in the community. I liked surgery, but I found my home while doing my shifts in the emergency department. So, I left general surgery and was a bastard of emergency medicine for 11 years: I worked in emergency departments supervising medical, surgical, and pediatric residents, even though I had not completed a residency in emergency medicine. You could do that back then.

I had opportunities to do an emergency medicine residency, but I’d always had to decline. I have 8 daughters, and it was not fair to take a residency position requiring 70 hours or more a week. I had already lost a couple of years of my oldest daughter’s childhood when I was in surgery residency, and while my husband was an amazing hands-on dad, he also had a demanding career. The bottom line was that I could only work about 40 hours a week.

When I was 38, with 8 kids between 5 and 18, I was working at Washington University and the university was approved for a new residency program. I took a 75% pay cut, a 50% time increase, and went back to residency. I don’t regret it for a second. It was an amazing opportunity for which I am very grateful. When I finished residency, there was a need for residency leadership, and I eagerly became involved in the evolution of our early training program. I was coordinating conferences and didactics, lecturing a couple hours most weeks, and trying to fill holes as needed. I took ultrasound technician courses at the local community college and eventually started our ultrasound program. I saw the need for a difficult airway program, so I coordinated the equipment purchase and incorporated the training into our education program. I was simultaneously in charge of our critical procedures lab and assisting with integrating simulation into our curriculum. I was involved in process improvement and with various hospital committees. I also managed to find time for some research and even some national speaking.           

I don’t mention these to show how awesome I am, and I certainly did not do all those things alone. Rather, I bring this up as a reflection of how I believe women my age approached our jobs during that time. I did all of those things, which are now done by multiple people, because they needed to be done. They needed to be done while working 24-28 clinical hours a week and parenting 8 kids. For 15 years, I slept an average of 4-6 hours a night, and my mostly male colleagues with wives who took care of their kids and homes actually made fun of me because I would fall asleep on night shifts!

It never occurred to me to ask for any concessions of time, schedule, or money because as a woman in a primarily male field, I did not want to appear weak, or even worse, needy. The extent of my negotiation when I went back to my old job after residency was asking to make at least as much as I had before. Originally, they had boldly offered $5000 less per year—when I had just completed more training! The only reason I had the courage to push for my original salary was because I didn’t know how I would explain to my husband that I tortured our family for 3 years only to make less money than before. Don’t get me wrong, I love my job and the people I have worked with for the last 25 years. To me, it was just how things were, and I plugged away with endless dedication.

I mentored people in my areas of expertise and helped with recruiting. Over time, people I had mentored became the “content experts” in different areas: directors of ultrasound, directors of simulation, directors of education, etc. I have been an assistant program director since I graduated, but I have never been the director of anything. To be fair, I did not want the title of program director because organization, attention to detail, and administration is not in my skill set. I did not want to be ultrasound director. I had already done ultrasound for 15 years and had moved on to other areas of interest. But still, even though it made me proud, it also kind of hurt to see my residency “kids” become directors while I was not advancing.

About 10 years ago, something happened that really opened my eyes. I was talking to our division chief about hiring a new ultrasound director, and he told me that the position had 16 clinical hours a week. I did not say anything, but I was angry. How was it that I had done that position, APD, critical procedures, simulation, and difficult airway for all of those years and worked 24 clinical hours a week? But somehow, now that position alone justified only 16 clinical hours? I took my injured heart and confusion to the keyboard and wrote an email to my boss. It was long. It was passionate. It listed all of the things I had been doing, all the sacrifices I had made, all the time I had missed with my family because I was working so hard for the division. I knew I shouldn’t send it, and I caught myself before hitting the button. But I kept it there in my draft box. I kept going back to it like a journal, adding, editing, and saving. I’m sure you can see where this is going. Yes, one of those times, I hit “send” instead of “save.” I didn’t even realize it was sent until I got an email from my boss that said he had read it, he was thinking about, and wanted to talk to me. I was horrified.

We had the much-needed and dreaded conversation. For your benefit, here is what I learned. My boss was unaware of all of the things I was doing for our department. He didn’t realize I had mentored the folks who later got the credit for being the content experts. He didn’t know because I never said anything. I didn’t get any concessions in hours or money because I never asked for any. My boss is a great guy; I respect him tremendously, but as he put it, he had spent a lot of time greasing the squeaky wheels and not paying attention to the cogs that kept the machine running. And that is where I come in, that is where my responsibility for my career lies. I assumed that he knew. Like many of us, it is not in my nature to toot my own horn. I think that is a really important gender difference for women of my age, and for a lot of younger women, as well.

So, what is my point? Here is my point. Don’t make the same mistakes I did. It is okay, and even necessary, to take credit for the things you are doing for your department, residents, and patients. Make sure that leadership is aware. It is okay and necessary to ask for time or schedule considerations. You should look for a group that allows for flexibility. It’s okay to ask for mentoring and it’s necessary to have ambitions and goals. It’s okay and necessary to ask for pay transparency and equity. Believe me, the men are doing it. And that’s okay, too. Policies that are good for women are also good for men.

You may be wondering, what was the result of my unleashed email of fury that led to the conversation with my boss? Let’s just say that I was heard. I spoke, and I was heard. I got the time and I got the money. The irony of that is now my kids have grown, and I don’t have the same demands on my time. I needed the time concessions twenty years ago when my kids were at home. But that, my friends and colleagues, is a topic for another time.

By Chandra Aubin, MD